真心痛者，水来克火，寒邪直犯君主，脘痛呕吐，身冷，手足青至节，甚则旦发夕死，茯神四逆汤主之。
茯神四逆汤（自制）
茯神（二钱） 附子（三钱） 干姜（一钱） 人参（二钱） 甘草（五分）
木香（六分） 砂仁（一钱） 水三钟，煎至一钟，微温服。
此方以四逆为主方，加茯神入心，以人参佐之。先生云，人参大补心脾。证见脘痛呕吐，用香、砂以调之，
则寒邪去而心痛止矣。祖怡注。
朱祖怡姻世丈，字漪垒，为外曾祖母朱太君外家之侄孙。常州同乡，前清孝廉。年长于我，与我先后同
时受医学于绳甫先生。晋卿公善于阐发长沙，漪垒颇喜精思，会心不远，又从而阐发费氏学。今已作
古，不忍没其苦心，爰随原文附注于下，加祖怡注三字以别之。徐相任识。
厥心痛者，中寒发厥而心痛也。虽在包络，然已是心之外腑，故手足厥逆，身冷汗出，便溺清利，甚亦朝发
夕死，白术四逆汤主之。
白术四逆汤（自制）
白术（三钱） 附子（三钱） 干姜（一钱） 人参（二钱） 茯苓（二钱）
甘草（五分） 大枣（三枚） 水三钟，煎一钟，微温服。
此方亦以四逆为主，而加白术命名者，其补土之意，已了然矣。其实理中加附子法，亦即四逆加四君
法，火土相生，虚寒兼顾，乃温补法也。祖怡注。
True Heart Pain is caused by Water overcoming Fire, where Cold Evil directly invades the Monarch (Heart). It manifests as epigastric pain and vomiting, coldness of the body, and cyanosis of the hands and feet extending to the joints. In severe cases, death may occur within the same day (morning onset with evening death, or vice versa). The treatment is primarily governed by Fushen Sini Tang (Poria Decoction for Reversing Yin).
Fushen Sini Tang (Self-made Formula)
Ingredients: Poria (Fu Shen, 2 qian), Aconite Root (Fu Zi, 3 qian), Dried Ginger (Gan Jiang, 1 qian), Ginseng Root (Ren Shen, 2 qian), Licorice Root (Gan Cao, 5 fen), Costus Root (Mu Xiang, 6 fen), Amomum Fruit (Sha Ren, 1 qian).
Preparation and Administration: Decoct with three units of water until one unit remains, and take warm.
This formula uses Sini Tang (Four Counterflow Decoction) as the main base, adding Poria (Fu Shen) to enter the Heart channel, assisted by Ginseng (Ren Shen). The Master stated that Ginseng greatly tonifies the Heart and Spleen. When symptoms such as epigastric pain and vomiting are present, using Costus (Mu Xiang) and Amomum (Sha Ren) to regulate Qi will dispel the Cold Evil and stop the heart pain. (Zuyi's Note)
Zhu Zuyi was my senior relative by marriage, courtesy name Yilei. He was the grandson-nephew of my maternal great-grandmother Zhu Taijun's maiden family. He was a fellow townsman from Changzhou and a Xiaolian (Juren degree holder) in the late Qing Dynasty. He was older than me, and we sequentially studied medicine under Mr. Shengfu at the same time. Mr. Jinqing excelled in elucidating the teachings of Zhang Zhongjing (the Prefect of Changsha), while Yilei preferred profound thinking and quick comprehension, further elaborating on the academic theories of Fei Boxiong (Fei School). As he has passed away, I cannot bear to obscure his painstaking efforts; therefore, I append notes below the original text, marked with "Zuyi's Note" to distinguish them. (Recorded by Xu Xiangren)
Jue Heart Pain refers to heart pain triggered by Cold invasion leading to Jue (reversal/cold extremities). Although the pathology involves the Pericardium (Bao Luo), it has already affected the outer organ of the Heart. Consequently, patients exhibit cold extremities, cold sweat, and clear urination and defecation. Severe cases may also result in death within the same day. The treatment is primarily governed by Baizhu Sini Tang (Atractylodes Decoction for Reversing Yin).
Baizhu Sini Tang (Self-made Formula)
Ingredients: Atractylodes Rhizome (Bai Zhu, 3 qian), Aconite Root (Fu Zi, 3 qian), Dried Ginger (Gan Jiang, 1 qian), Ginseng Root (Ren Shen, 2 qian), Poria (Fu Ling, 2 qian), Licorice Root (Gan Cao, 5 fen), Jujube (Da Zao, 3 pieces).
Preparation and Administration: Decoct with three units of water until one unit remains, and take warm.
This formula is also based on Sini Tang, named after the addition of Atractylodes (Bai Zhu), clearly indicating its intention to tonify Earth (Spleen/Stomach). Essentially, the method of adding Aconite to Lizhong Tang (Regulate the Middle Decoction) is equivalent to adding the Four Gentlemen Decoction (Sijunzi Tang) to Sini Tang. This reflects the generative relationship between Fire and Earth, addressing both deficiency and cold, constituting a warming and tonifying method. (Zuyi's Note)